The Effect of Some Biochemical and Physiological Parameters in Iraqi Patients with Renal Failure

Background: Renal failure occur when the kidneys are unable to bring out the body's metabolic wastes or proceed their regulatory assignment. Objective The study was designed to compere some biochemical and hematological parameters in patents with renal failure and control group. Patients and materials: A case-control study was conducted from September 2018 t0 April 2019 on patients attending the artificial Kidney Unit in Al-Hussein Hospital in holy Karbala Governorate. A total of fifty known cases of renal failure and fifty health persons were selected. Blood samples were taken from both (patients and control) to estimate biochemical and hematological parameters by using specific methods. Results: the results of this study found the high increase (P˂0.05) in concentration of blood urea, serum creatinine, and calcium levels, a significant decreases (P ≤ 0.05) in (Hb) and (PCV) in patients while (ESR) rate were significantly increased (P ≤ 0.05) in these patients when compared to healthy control. Conclusion: In this study conclude that the biochemical parameters are more efficient than hematological parameters in follow-up cases of patients with renal failure.

on the history, clinical examination and taking renal function tests"."The study consist of 50 patients (25 males, 25 females) and 50 obviously healthy individuals (23 males, 27 females) from (20 -70) years old of age. All patients included in this study were non diabetic, non-alcoholism, without viral hepatitis. (5 ml) Venous blood was drawn from each patient Serum was then separated for (10) minutes by centrifugation ". Biochemical tests such as blood urea, Serum creatinine were measured by semi-auto analyzerBA-88A (Korea). The electrolyte such as Calcium was estimated by using Genex Elyte 4 device according to manufactured company that approved with it. The criteria of hematology, hemoglobin (Hb) concentration, packed cell volume (PCV) were measured by using automated hematological cell counting (USA) and ( ESR) was Evaluated by western green method ".

2-2-Statistical analysis
All statistical procedures of the present article have been carried out by using Excel programs and statistically available software; Statistical Package for the Social Sciences (SPSS) Version 18 by using the Pearson correlation method. All values as mean ± standard deviation (SD) are expressed. Differences were considered to be significant when the probability (P) was less than P≤ 0.05".

3-Result
Table1: frequency of gender and age among patients and control The results showed that the patients were enrolled and control were distributed according to gender and age group as shown in table(1)"patients were divided into two groups, the male group forming ( 50%) of them was found to be equal to female group( 50%) while the two groups of control forming (46%) for male and (54%) for female". In the same table The distribution of age in renal failure was high in the age (<45) years represented by 31 (62%) patients and 24(48%) for control.  Table (2) show a significant change in serum of the diagnostic parameters of kidney functions :blood urea (BU), creatinine (Cr) and calcium (Ca) in comparison to healthy control. There is a substantial increase (P˂0.05) in concentration of blood urea, serum creatinine, and calcium when compared to healthy control".  Table (3) showed a hematological parameters in blood serum such as hemoglobin (Hb) , packed cell volume (PCV) and erythrocyte sedimentation rate (ESR) and the were a significant decreases (P ≤ 0.05) in (Hb) and (PCV) in patients when compared to healthy control while (ESR) rate were significantly increased (P ≤ 0.05) in these patients when compared to healthy control".

4-DISCUSSION:
The study result showed a high incidence of biochemical analysis and hematological tests for renal failure patents versus healthy individuals. The present study included 50 patents suffering from renal failure (25 male, 25 female) as compared with 50 person healthy individuals (23 male, 27 female) as control group and their ages were similar and ranged from (20-<45) as shown in table (1). Kidney failure occurs when the kidneys can not eliminate or perform their regulatory role of body metabolic waste. Substances that are normally disposed of in urine develop in the body fluids due to affected renal excretion and lead to disturbance in the endocrine, metabolic and fluid, electrolyte, and acid-base functions of the body. Renal failure is a systemic illness and is the most prevalent mechanism for many different diseases of the renal and urinary tract. Each year an estimated 42,000 Americans die of irreversible kidney failure [10,11] .
*In current study there was high significant increase in blood urea, serum creatinine and calcium levels in renal failure patients (p 0.00) as shown in table (2)"serum urea increase was mainly caused by the development of the disease, but is heavily influenced either by a catabolic condition or by excessive protein intake, which leads to increased production of protein catabolism waste [12] . meanwhile, an increase in creatinine levels is due to a reduced number of working nephrons in patients with renal failure in the serum which would decrease the GFR, which is responsible for a significant decrease in water and solutes [13] . In kidney failure patents, excess calcium concentration due to intestinal calcium absorption appears to be reduced. Calcium fractional absorption is inversely related to blood urea concentration. Chronic renal failure patients appear to consume less calcium than normal individuals in their diets his result is consistent with" [14]* .
(In other hand there was a significant decrease (p 0.02) in hematological parameters such as hemoglobin, PVC as shown in table (3) This result was compatible with [15] because of the (EPO ) erythropoietin hormone induces the action of bone marrow to produce (RBCs) when the kidneys are affected as in patents for renal failure, they do not generate sufficient EPO. As a result, little is achieved by the bone marrow to make (RBCs), which causes anaemia. Certain causes of anaemia in patients with renal failure due to low levels of the following minerals and vitamins contained in meals: vitamin B12, iron , folic acid required for (RBCs) to make haemoglobin, the primary oxygen-carrying protein in haemoglobin (RBC).while the level of ESR in patents increase significantly(p 0.01) in compared with healthy individual elevation of the erythrocyte sedimentation rate (ESR) is mostly due to inflammation and infection as a results of the vascular disease and catabolic processes occurring in renal failure as a cause or complements, which are most probably due to elevated circulating levels of inflammatory cytokines such as interleukin-6 [16]) .

Conclusion
Notes from the above results showed that biochemical parameters levels significantly increased in patients with renal failure otherwise hematological parameters in patients significantly decreased such as (Hb) and (PVC) unlike (ESR) found significantly increased, though the biochemical parameters are more efficient than hematological parameters in follow-up cases of patients with renal failure.